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STATE OF CALIFORNIA• DEPARTMENT OF TRANSPORTATION <br /> ENCROACHMENT PERMIT <br /> TR-0120(REV 2198) Permit No <br /> 1004-6TK-0047 <br /> DisVCo/RtelPM <br /> In compliance with (Check one) <br /> 10-SJ-580-13 38113 69 <br /> ® Your application of JANUARY 15, 2004 <br /> Date <br /> ❑ Utility Notice No of JANUARY 22,2004 <br /> Fee Paid Deposit <br /> ❑ Agreement No of $ $ 246 <br /> Performance Bond Amount(1) Payment Bond Amount <br /> ❑ RNV Contract No of $ $ <br /> Bond Company <br /> Bond Number(1) Bond Number(2) <br /> TO <br /> ARCO <br /> CIO STATUS ENVIRONMENTAL, INC <br /> 3330 CAMERON PARK DRIVE, SUITE 550 <br /> CAMERON PARK, CA 95682 <br /> ATTN SCOTT BITTINGER <br /> TEL (530) 576 2062 <br /> I I <br /> , PERMITTEE <br /> and subject to the following, PERMISSION IS HEREBY GRANTED to <br /> Install roadwork sign on the 1-580 northbound off-ramps and southbound off-ramp to <br /> warn public traffic of the road work ahead <br /> In accordance with General Provision No 6, TWO WORKING DAYS PRIOR to the start <br /> of this work, Permittee shall notify the State Representative MARCEL DE LA CRUZ, <br /> P O Box 2048 Stockton, CA 95201, (209) 948-3656 All work under this permit must <br /> meet with the approval of the State Representative <br /> The following attachments are also included as part of this permit In addition to fee,the permittee will be billed <br /> (Check applicable) actual costs for <br /> ® Yes ❑ No General Provisions ❑ Yes ® No Review <br /> ❑ Yes ® No Utility Maintenance Provisions ❑ Yes ® No Inspection <br /> ® Yes ❑ No Special Provisions T ® Yes ❑ No Field Work <br /> ❑ Yes ® No A Cal-OSHA permit required prior to beginning work, <br /> # (If any Caltrans effort expended) <br /> ❑ Yes ® No The information in the environmental documentation has been reviewed and is considered prior to approval of this <br /> _ permit _ <br /> This permit is void unless the work is completed before JULY 31, 2004 <br /> This permit is to be strictly construed and no other work other than specifically mentioned is hereby authorized <br /> No project work shall be commenced until all other necessary ermits and environmental clearances have been obtained <br /> 1 -Permittee APPROVED <br /> I -File <br /> 3—M OE IA CRUZ <br /> JULIE DUNNING, Acting District Director <br /> BY J / <br /> Pete <br /> LEX MEN Dl trict Permit rr ineer if ` <br /> FM 91 1436 <br />